Abstract 18710: Improvements in Glycemic Control in Type 2 Diabetes Do Not Lead to Reductions in Circulating Cardiac Troponin

Abstract

Objective: Concentrations of cardiac troponin T, when measured with a high-sensitivity assay (hsTnT), have emerged as a strong marker of cardiovascular mortality, and are frequently elevated in patients with type 2 diabetes. Whether glycemic control affects concentrations of this marker is unknown. Methods and Results: We measured hsTnT in patients from the LANCET trial, a 14 week, 2x2 factorial, randomized, placebo-controlled trial of insulin glargine and metformin in early type 2 diabetes. Baseline and 14-week follow up samples were available from 438 participants. At baseline, 408 out of 438 (93.2%) had detectable circulating hsTnT, while 59 (13.5%) had hsTnT levels above the established upper reference limit (≥ 14 ng/L). At baseline, the median (IQR) HbA1c was 6.9% (6.3-7.7%) with no significant differences by treatment group. Statistically significant associations with baseline natural logarithm transformed hsTnT were noted for age (ρ=0.09, P<0.05), but not fasting glucose, HbA1c, body mass index, interleukin-6, or high-sensitivity C-reactive protein (each P>0.26). After 14 weeks of randomly allocated therapy, we observed a significant reduction in HbA1c in all treatment groups except placebo (Figure). In models adjusted for baseline hsTnT and baseline antihyperglycemic therapy we observed no over all change in hsTnT by random treatment allocation (P=0.92) and no individual treatment group differences relative to placebo (Figure; each P≥0.37). Conclusions: These data suggest that aggressive glucose control with insulin glargine, metformin, or the combination does not alter concentrations of circulating cardiac troponin T. Our findings are concordant with the results of large randomized controlled trials showing that glycemic control alone may not suffice to substantively lower cardiovascular risk. (Clinicaltrials.gov Identifier: NCT00366301 )